Quote:

 

http://www.washingtonpost.com/politics/health_care/study-rise-in-er-visits-after-medicaid-expansion/2014/09/08/c7d53e7c-378a-11e4-a023-1d61f7f31a05_story.html

Study: Rise in ER visits after Medicaid expansion

WASHINGTON — Many people newly insured by Medicaid under the federal health care law are seeking treatment in hospital emergency rooms, one of the most expensive medical settings, a study released Monday concludes.

The analysis by the Colorado Hospital Association provides a real-time glimpse at how the nation’s newest social program is working.

It also found indications that newly insured Medicaid patients admitted to hospitals may be sicker than patients previously covered under the same program, which serves more than 60 million low-income and disabled people.

The findings have implications for federal and state policymakers managing the coverage expansion under President Barack Obama’s health care law. Taxpayers could save millions of dollars if newly insured Medicaid patients with routine needs are steered to community health centers or urgent care clinics, as opposed to service-intensive ERs.

The Affordable Care Act expanded Medicaid to cover many low-income adults with no children living at home. They were previously ineligible in nearly every state. About 7 million people nationally have been added to the rolls of the safety-net program, which is jointly run by the federal government and the states.

[...]

Looking at the broad sample of 25 states, the study found that the average number of ER visits in states that expanded Medicaid increased by 5.6 percent, when the second three months of this year were compared with the same period in 2013. That increase was more than three times bigger than experienced by hospitals in states that did not expand. It was also outside the range of normal year-to-year fluctuations, Tholen said.

[...]

The study also found notable declines in hospital charity and self-pay charges for states that expanded Medicaid. But researchers said it will take more time to get a full picture of the impact on hospital finances.

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http://online.wsj.com/articles/casey-b-mulligan-the-myth-of-obamacares-affordability-1410218437

The Myth of ObamaCare's Affordability
The law's perverse incentives will have the nation working fewer hours, and working those hours less productively.

Whether the Affordable Care Act lives up to its name depends on how, or whether, you consider its consequences for the wider economy.

Millions of people pay a significant portion of their income for health insurance so they and their families can get good health care when they need it. The magnitude of their sacrifices demonstrates the importance that people ascribe to health care.

The Affordable Care Act attempts to help low- and middle-income families avoid some of the tough sacrifices that would be necessary to purchase health insurance without assistance. But no program can change the fundamental reality that society itself has to make sacrifices in order to deliver health care to more people. Workers and therefore production have to be taken away from other industries to beef up health care, or the workforce itself has to get bigger, or somehow people have to work more productively.

Although the ACA helps specific populations by giving them a bigger slice of the economic pie, the law diminishes the pie itself. It reduces the amount that Americans work, and it makes their work less productive. This slows growth in both personal income and gross domestic product.

In further expanding the frontiers of redistribution, the ACA reduces the benefits of employment for both employers and employees. Employers that don't provide health insurance are either subject to large penalties based on the number and types of employees that they have, or are threatened with enormous penalties when they get the opportunity to expand their business. About a quarter of the nation's employees, more than 35 million men and women, currently work for employers that don't offer health insurance. These tend to be small and midsize businesses with employees who already make less than the average American worker. The result of penalizing businesses for hiring and expanding is going to be less hiring and expanding.

Another sixth of the nation's employees—almost 25 million people—are in a full-time position that makes them ineligible for the law's new and generous assistance with health-insurance premiums and cost sharing. They are ineligible for subsidies simply because they are working full time and thereby eligible for their employers' coverage. Because the only ways for them to get the new assistance is to move to part-time status, find an employer that doesn't offer coverage, or stop working, we can expect millions of workers to make one or more of those adjustments.

Most people wouldn't give up working merely to qualify for a few thousand dollars in assistance. But it is a mistake to assume that nobody is affected by subsidies, because there are people who aren't particularly happy with working, planning to leave their job anyway, or otherwise on the fence between working and not working. A new subsidy is enough to push them over the edge or to get them to stop working sooner than they would have otherwise.

The law has effects that extend well beyond the employment rate and the average length of the workweek. People, businesses and entire sectors will jockey to reduce their new tax burdens or enhance their subsidies. Their adjustments to the new incentives will make our economy less productive and stifle wage growth, even among workers who have no direct contact with the law's penalties and subsidies.

The "29er" phenomenon is a good example of how the law harms productivity. Because ACA's "employer mandate" requires firms with 50 or more full-time workers to offer health plans to employees who work more than 30 hours a week, many employers and employees have adopted 29-hour work schedules. This is not the most productive way to arrange the workplace, but it allows employers to avoid the mandate and its penalties and helps the employees qualify for individual assistance.

All of this, and much more, exacerbates the societal problem that the economy cannot expand its health sector without giving up something else of value. A complex law like the ACA has a few provisions that encourage work, such as counting unemployment income against eligibility for health assistance. But the bulk of the law overwhelms them. The ACA as a whole will have the nation working fewer hours, and working those hours less productively.

I estimate that the ACA's long-term impact will include about 3% less weekly employment, 3% fewer aggregate work hours, 2% less GDP and 2% less labor income. These effects will be visible and obvious by 2017, if not before. The employment and hours estimates are based on the combined amount of the law's new taxes and disincentives and on historical research on the aggregate effects of each dollar of taxation. The GDP and income estimates reflect lower amounts of labor as well as the law's effects on the productivity of each hour of labor.

By the end of this decade, nearly 20 million additional Americans will have health insurance as a consequence of the law. But the ultimate economywide cost of their enrollments will be at least double what it would have been if these people had enrolled without government carrots and sticks; that is, if they had decided it was worth spending their own money on health insurance. In effect, people who aren't receiving assistance through the ACA are paying twice for the law: once as the total economic pie gets smaller and again as they receive a smaller piece.

The Affordable Care Act is weakening the economy. And for the large number of families and individuals who continue to pay for their own health care, health care is now less affordable.

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http://www.washingtonpost.com/blogs/fact-checker/wp/2014/09/10/an-obamacare-attack-ad-stuck-in-a-time-warp/

An ‘Obamacare’ attack ad stuck in a time warp
By Glenn Kessler

• 
  
• “On TV, Mark Pryor talks about the health-care law he helped pass. What Pryor doesn’t say is that law was Obamacare. Or that it cuts over $700 billion from our Medicare and will cut benefits seniors rely on. Obamacare meant threatened insurance plans, higher premiums, and broken promises.”
  –voiceover of Crossroads GPS ad attacking Sen. Mark Pryor (D-Ark.)

Sen. Mark Pryor, one of the endangered Red State Democrats seeking reelection, made waves over the summer when he took the unusual step of running an ad defending the Affordable Care Act—but without mentioning the law by name. (“That’s why I helped pass a law that prevents insurance companies from canceling your policy if you get sick, or deny coverage for preexisting conditions,” he said in the ad.)

This response from pro-GOP Crossroads GPS seeks to remind voters that the law in question is actually “Obamacare.” But are its claims getting a bit stale?

The Facts

Regular readers know that The Fact Checker and other fact checking organization have long criticized the use of the $700-billion figure. That number comes from the difference over 10 years (2013-2022) between anticipated Medicare spending (what is known as “the baseline”) and the changes that the law makes to reduce spending. The savings mostly are wrung from health-care providers, not Medicare beneficiaries — who, as a result of the health-care law, ended up with new benefits for preventive care and prescription drugs.

The ad flashes a headline saying Arkansas seniors faced a $1,295 cut in benefits, which it attributes to a study by the right-leaning American Action Forum, which has long been critical of the law. But this study focuses on alleged cuts in benefits for Medicare Advantage, a private-plan alternative to traditional Medicare used by about 27 percent of beneficiaries. In other words, not all seniors would face benefit cuts — and many others would gain benefits.

As we have noted before, the law sought to restrain the growth in Medicare Advantage, to the tune of $145 billion over 10 years, as it costs the U.S. government more per senior than fee-for-service Medicare. But under political pressure, the administration has also reversed some cuts that were to take place under the law.

The most dated assertion in the ad is that the law “threatened insurance plans [and] higher premiums.”

The phrase about “threatened” plans refers to the initial reports that hundreds of thousands of people in the individual market would lose the plans that did not comply with the law. However, a series of regulatory actions by the Obama administration mitigated that concern. The situation varies in different states, but Arkansas has deferred the phase-out of non-compliant plans until 2017.

The phrase “threatened” appears to be a sly way to get around the fact that, in the end, relatively few plans were affected—just that they were threatened to be affected. It also ignores the facts that a recent Gallup poll found that because of the law Arkansas led the nation in having the sharpest drop in the number of adults without health insurance—a decline of more than 10 percentage points.

As for rising premiums, the ad cites a 2013 report by a conservative organization that sought to document the increase in premiums before and after the law. But it’s very difficult to do an apples to apples comparison because the law does not allow insurance carriers to bar coverage to people with pre-existing conditions—and also mandates a robust package of benefits. The impact of the changes can vary depending on your age and where you live, making it more difficult to make broad comparisons.

Moreover, just one week before the ad began to air, Arkansas announced that insurance premiums would actually decline in 2015.

Paul Lindsay, a Crossroads spokesman, said: “As you’ll notice, our ad is in the past tense (“meant threatened insurance plans, higher premiums…”) and is about actions that have already occurred because of Obamacare.”

[...]

Three Pinocchios

Link from Mason in another thread...

 

http://freebeacon.com/politics/obamacare-costs-250k-virginians-their-healthcare/

Obamacare Costs 250K Virginians Their Healthcare

Obamacare’s nuances have made several healthcare plans in Virginia obsolete, hence depriving nearly a quarter million Virginias of their heath coverage according to NBC Richmond.

That adds to the already over 800,000 Virginians who’ve been forced away from their current plans and had to enroll under more expensive plans that are Obamacare-approved.

Linked from that article...

 

http://www.politifact.com/virginia/statements/2014/jul/20/barbara-comstock/barbara-comstock-said-millions-virginians-lost-ins/

... the Truth-O-Meter.

There’s no exact count on how many Virginians were notified last year that their plans would be ended because of Obamacare. A state health insurance lobbyist estimates the number at 850,000. But these people still had options; they or their employer could renew their old plans for another year or switch to new coverage....

Quote:

 

http://www.politico.com/story/2014/09/workplace-insurance-coverage-obamacare-110820.html

Workplace insurance coverage levels steady in year one of Obamacare
By BRETT NORMAN

The Affordable Care Act so far has had little impact on the insurance people get through their jobs— countering dire predictions by Obamacare critics that employers would dump coverage and steer workers toward the new insurance exchanges.

And premiums rose just 3 percent, according to a respected annual survey released Wednesday.

It’s only year one of the Obamacare exchanges, and the findings won’t quell the debate about how businesses will respond in the coming years to new requirements and more regulatory and economic changes to the health industry.

But the steady availability of employer-sponsored coverage and the “extraordinarily modest” premium rise indicate that predictions that “the sky would fall” under Obamacare have not come to pass, said Drew Altman, president of the nonpartisan Kaiser Family Foundation, which conducted the study with the Health Research and Education Trust.

[...]

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http://www.latimes.com/business/money/la-fi-employer-health-costs-20140910-story.html

Employer health rates rise 3%, worker deductibles top $1,200


[Where on that chart did Barry take office?]

[...]

"Large employers are skeptical the current low trends will continue for a variety of reasons," said Bill Kramer, executive director for national health policy at the Pacific Business Group on Health, which represents large employers such as Boeing Co. and Walt Disney Co.

[...]

The average employee deductible has increased 47% since 2009 to $1,217 annually. Eighteen percent of workers face a deductible of at least $2,000. Workers typically must pay that amount before most medical services are covered by their health plan.

Some health-policy experts credit higher deductibles with helping hold down medical costs by discouraging people from getting care or motivating them to be savvier shoppers. But throwing up barriers to cost-saving preventive care is a potential downside.

"Higher deductibles may be good if you're relatively young and healthy," said Drew Altman, chief executive of the Kaiser Family Foundation in Menlo Park, Calif. "But they may be a bad thing if you are lower or moderate income or chronically ill. This can be a real burden on the family budget."

For a change this year, the growth in employer health premiums was close to the annual increase in workers' wages at 2.3% and inflation of 2%

[...]

Quote:

 

http://www.washingtonpost.com/politics/house-senate-debate-measures-going-nowhere/2014/09/11/cce2f2ca-3982-11e4-a023-1d61f7f31a05_story.html

House, Senate debate measures just to make points

On both ends of the Capitol, the parties controlling Congress are happily showcasing futility.

Less than two months before pivotal congressional elections, Republicans muscled legislation through the House Thursday letting insurers continue selling health coverage that falls short of standards required by President Barack Obama’s health care law. The measure passed on a 247-167 vote but is sure to die in the Democratic-run Senate, and the White House promised a veto in any event.

Even so, the vote let Republicans highlight their repeated efforts to debilitate the health care law. With 25 Democrats voting “no,” it gave Republicans a chance to accuse them of opposing the idea of letting people keep insurance they already have — an Obama promise that proved untrue for some consumers.
[...]

Quote:

 

http://joshblackman.com/blog/2014/09/12/i-am-not-a-lawyer-ny-times-edition/

I Am Not A Lawyer. NY Times Edition.

A common abbreviation you see in the comment threads of legal blogs is IANAL, or “I am not a lawyer.” Usually, when I see that abbreviation, I stop reading. It suggests that the person has absolutely no idea what he’s talking about, and even conceding he has no formal legal training, proceeds to offer a legal opinion.

I was thus shocked to see this line in the New York Times, in an Op-Ed on Halbig:

• 
  
• We are economists, not lawyers. But…

It doesn’t really matter what comes next. Three economists, who admit they have no legal training, were given a lengthy Op-Ed on Page A27 of the New York Times to explain to us principles of statutory interpretation. Mind you one of the economists, Peter Orszag, was Obama’s Director of OMB during the passage of the ACA!

What is most fascinating about this Op-Ed, is that it serves as an effort to persuade the Justices *not* to grant certiorari in King v. Burwell while the Halbig case is pending rehearing en banc.

• 
  
• If the full District of Columbia Circuit takes up the case, it should reject this sophistry. Meanwhile, the Supreme Court should wait to see what the lower courts do before deciding whether to intervene.

I don’t have any comments on their economic analysis of the case, but they should have confined their writing to their area of expertise. I–and no one else–should give a flip what they think about the Court’s certiorari process, let alone views of statutory interpretation.

This editorial comes on the heels of a editorial urging the D.C. Circuit to grant rehearing en banc.

Folks, we now have briefs of amicus curiae supporting and opposing certiorari in the form of New York Times editorials. By non-lawyers.